Provider Demographics
NPI:1417411273
Name:NIDO CEBOLLERO, ANA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:VICTORIA
Last Name:NIDO CEBOLLERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 CALLE LUCHETTI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1822
Mailing Address - Country:US
Mailing Address - Phone:787-364-6442
Mailing Address - Fax:
Practice Address - Street 1:1219 CALLE LUCHETTI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1822
Practice Address - Country:US
Practice Address - Phone:787-364-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6117585390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program